Understanding epiretinal membrane: Causes, symptoms, and management

An epiretinal membrane (ERM), sometimes called macular pucker or cellophane maculopathy, is a thin layer of scar-like tissue that forms on the inner surface of the retina. More specifically, it usually develops over the macula—the area responsible for central, detailed vision. Although usually not dangerous to eye health, an ERM can distort vision and affect daily tasks such as reading or recognising faces. In some cases, ERM can worsen with time.

Epiretinal membranes typically form when cells accumulate on the retinal surface and begin to contract. This contraction can wrinkle or pull on the macula, leading to visual changes. The condition most commonly occurs with aging and is often linked to normal age-related changes in the vitreous, the gel-like substance inside the eye. When the vitreous separates from the retina—a process called posterior vitreous detachment—it may trigger membrane formation. There are also more concerning causes of ERM such as inflammation, retinal vascular disease, retinal vein occlusion, trauma and tumours. This means examination by an expert is important to determine the cause. 

Symptoms vary depending on the membrane’s thickness and the amount of macular distortion. Many people experience only mild visual disturbances or remain completely unaware of the condition. Others may notice blurred or distorted central vision, straight lines appearing wavy, or difficulty reading small print. Peripheral vision is usually unaffected. Symptoms can sometimes worsen with time and delayed surgery can in some cases result in a worse long term visual prognosis.

Diagnosis is typically made through a dilated eye examination and confirmed with optical coherence tomography (OCT), a noninvasive imaging tool that provides detailed cross-sectional images of the retina.

For mild cases, observation is often all that’s needed. When vision becomes significantly affected, a surgical procedure called vitrectomy with membrane peeling may be recommended. During this procedure, the surgeon carefully removes the membrane to relieve traction on the macula. Most patients experience visual improvement after surgery.

Overall, an epiretinal membrane is a manageable condition, and regular eye exams help ensure timely detection and appropriate care.